Neuroprotective effects of Si-based hydrogen-producing agent on 6-hydroxydopamine-induced neurotoxicity in juvenile mouse model

Neurotoxins have been extensively investigated, particularly in the field of neuroscience. They induce toxic damage, oxidative stress, and inflammation on neurons, triggering neuronal dysfunction and neurodegenerative diseases. Here we demonstrate the neuroprotective effect of a silicon (Si)-based hydrogen-producing agent (Si-based agent) in a juvenile neurotoxic mouse model induced by 6-hydroxydopamine (6-OHDA). The Si-based agent produces hydrogen in bowels and functions as an antioxidant and anti-inflammatory agent. However, the effects of the Si-based agent on neural degeneration in areas other than the lesion and behavioral alterations caused by it are largely unknown. Moreover, the neuroprotective effects of Si-based agent in the context of lactation and use during infancy have not been explored in prior studies. In this study, we show the neuroprotective effect of the Si-based agent on 6-OHDA during lactation period and infancy using the mouse model. The Si-based agent safeguards against the degradation and neuronal cell death of dopaminergic neurons and loss of dopaminergic fibers in the striatum (STR) and ventral tegmental area (VTA) caused by 6-OHDA. Furthermore, the Si-based agent exhibits a neuroprotective effect on the length of axon initial segment (AIS) in the layer 2/3 (L2/3) neurons of the medial prefrontal cortex (mPFC). As a result, the Si-based agent mitigates hyperactive behavior in a juvenile neurotoxic mouse model induced by 6-OHDA. These results suggest that the Si-based agent serves as an effective neuroprotectant and antioxidant against neurotoxic effects in the brain, offering the possibility of the Si-based agent as a neuroprotectant for nervous system diseases.

LONRF2 is a protein quality control ubiquitin ligase whose deficiency causes late-onset neurological deficits

Protein misfolding is a major factor of neurodegenerative diseases. Post-mitotic neurons are highly susceptible to protein aggregates that are not diluted by mitosis. Therefore, post-mitotic cells may have a specific protein quality control system. Here, we show that LONRF2 is a bona fide protein quality control ubiquitin ligase induced in post-mitotic senescent cells. Under unperturbed conditions, LONRF2 is predominantly expressed in neurons. LONRF2 binds and ubiquitylates abnormally structured TDP-43 and hnRNP M1 and artificially misfolded proteins. Lonrf2-/- mice exhibit age-dependent TDP-43-mediated motor neuron (MN) degeneration and cerebellar ataxia. Mouse induced pluripotent stem cell-derived MNs lacking LONRF2 showed reduced survival, shortening of neurites and accumulation of pTDP-43 and G3BP1 after long-term culture. The shortening of neurites in MNs from patients with amyotrophic lateral sclerosis is rescued by ectopic expression of LONRF2. Our findings reveal that LONRF2 is a protein quality control ligase whose loss may contribute to MN degeneration and motor deficits.

Early life stress impairs brain and mental development during childhood increasing the risk of developing psychiatric disorders

In recent years, it has become known that stress in childhood, called early life stress (ELS), affects the mental health of children, adolescents, and adults. Child maltreatment (CM) is an inappropriate form of childcare that interferes with children's normal brain and mind development. Previous studies have reported that CM severely affects brain development and function. For example, ELS causes brain vulnerability and increases the risk of developing psychiatric disorders. In addition, it is known that the different types and timing of abuse have different effects on the brain. Epidemiological and clinical studies are being conducted to understand the mechanism underlying abuse on a child's mental health and appropriate brain development; however, they are not fully understood. Therefore, studies using animal models, as well as humans, have been conducted to better understand the effects of CM. In this review, we discuss the effects of comparing previous findings on different types of CM in human and animal models. However, it should be noted that there are differences between animal models and humans such as genetic polymorphism and susceptibility to stress. Our review provides the latest insights into the negative effects of CM on children's development and on psychiatric disorders in adulthood.

Genomic Strategies for Understanding the Pathophysiology of Autism Spectrum Disorder

Recent breakthroughs in sequencing technology and technological developments have made it easier to analyze the entire human genome than ever before. In addition to disease-specific genetic mutations and chromosomal aberrations, epigenetic alterations in individuals can also be analyzed using genomics. Autism spectrum disorder (ASD) is a neurodevelopmental disorder (NDD) caused by genetic and/or environmental factors. More than a thousand genes associated with ASD have been identified which are known to be involved in brain development. However, it is difficult to decode the roles of ASD-associated genes without in vitro and in vivo validations, particularly in the process of brain development. In this review, we discuss genomic strategies for understanding the pathological mechanisms underlying ASD. For this purpose, we discuss ASD-associated genes and their functions, as well as analytical strategies and their strengths and weaknesses in cellular and animal models from a basic research perspective.

Evolution of the Human Brain Can Help Determine Pathophysiology of Neurodevelopmental Disorders

The evolution of humans brought about a co-occurring evolution of the human brain, which is far larger and more complex than that of many other organisms. The brain has evolved characteristically in humans in many respects, including macro-and micro-anatomical changes in the brain structure, changes in gene expression, and cell populations and ratios. These characteristics are essential for the execution of higher functions, such as sociality, language, and cognition, which express humanity, and are thought to have been acquired over evolutionary time. However, with the acquisition of higher functions also comes the risk of the disease in which they fail. This review focuses on human brain evolution and neurodevelopmental disorders (NDDs) and discusses brain development, molecular evolution, and human brain evolution. Discussing the potential for the development and pathophysiology of NDDs acquired by human brain evolution will provide insights into the acquisition and breakdown of higher functions from a new perspective.

Prenatal methamphetamine exposure causes dysfunction in glucose metabolism and low birthweight

Methamphetamine (METH) is a psychostimulant drug that induces addiction. Previous epidemiological studies have demonstrated that maternal METH abuse during pregnancy causes low birthweight (LBW) in the offspring. As a source of essential nutrients, in particular glucose, the placenta plays a key role in fetal development. LBW leads to health problems such as obesity, diabetes, and neurodevelopmental disorders (NDDs). However, the detailed mechanism underlying offspring's LBW and health hazards caused by METH are not fully understood. Therefore, we investigated the effects of prenatal METH exposure on LBW and fetal-placental relationship by focusing on metabolism. We found dysfunction of insulin production in the pancreas of fetuses exposed to METH. We also found a reduction of the glycogen cells (GCs) storing glycogens in the junctional zone of placenta, all of which suggest abnormal glucose metabolism affects the fetal development. These results suggest that dysfunction in fetal glucose metabolism may cause LBW and future health hazards. Our findings provide novel insights into the cause of LBW via the fetal-placental crosstalk.

Prenatal Environment and Neurodevelopmental Disorders

The internal and external environment of the mother during the developmental stages of the fetus affects the offspring's health. According to the developmental origins of health and disease (DOHaD) theory, environmental factors influence the offspring and also affect health in adulthood. Recently, studies based on this theory have gained attracted attention because of their clinical utility in identifying the risk groups for various diseases. Neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) can be caused by exposure to certain prenatal environments during pregnancy. This review describes the latest findings on the effect of prenatal environment on the onset mechanism of NDDs based on the DOHaD theory. Unravelling the molecular mechanisms underlying the pathogenesis of NDDs is important, because there are no therapeutic drugs for these disorders. Furthermore, elucidating the relationship between the DOHaD theory and NDDs will contribute to the popularization of preventive medicine.

Transient expansion of the expression region of Hsd11b1, encoding 11β-hydroxysteroid dehydrogenase type 1, in the developing mouse neocortex

Corticosteroids are stress-related hormones that maintain homeostasis. The most effective corticosteroids are corticosterone (CORT) in rodents and cortisol in primates. 11β-Hydroxysteroid dehydrogenase type 1 (11β-HSD1; EC 1.1.1.146), encoded by Hsd11b1, is a key regulator of the local concentration of CORT/cortisol. Hsd11b1 expression in layer 5 of the primary somatosensory cortex has been shown in adult mice. However, its localization in the entire neocortex, especially during development, has not been fully addressed. Here, we established robust and dynamic expression profiles of Hsd11b1 in the developing mouse neocortex. Hsd11b1 was found mostly in pyramidal neurons. By retrograde tracing, we observed that some Hsd11b1-positive cells were projection neurons, indicating that at least some were excitatory. At postnatal day 0 (P0), Hsd11b1 was expressed in the deep layer of the somatosensory cortex. Then, from P3 to P8, the expression area expanded broadly; it was observed in layers 4 and 5, spanning the whole neocortex, including the primary motor cortex (M1) and the primary visual cortex (V1). The positive region gradually narrowed from P14 onwards and was ultimately limited to layer 5 of the somatosensory cortex at P26 and later. Furthermore, we administered CORT to nursing dams to increase the systemic CORT level of their pups. Here, we observed a reduced number of Hsd11b1-positive cells in the neocortex of these pups. Our observation suggests that Hsd11b1 expression in the developing neocortex is affected by systemic CORT levels. It is possible that stress on mothers influences the neocortical development of their children.

Interstitial Axon Collaterals of Callosal Neurons Form Association Projections from the Primary Somatosensory to Motor Cortex in Mice

Association projections from cortical pyramidal neurons connect disparate intrahemispheric cortical areas, which are implicated in higher cortical functions. The underlying developmental processes of these association projections, especially the initial phase before reaching the target areas, remain unknown. To visualize developing axons of individual neurons with association projections in the mouse neocortex, we devised a sparse labeling method that combined in utero electroporation and confocal imaging of flattened and optically cleared cortices. Using the promoter of an established callosal neuron marker gene that was expressed in over 80% of L2/3 neurons in the primary somatosensory cortex (S1) that project to the primary motor cortex (M1), we found that an association projection of a single neuron was the longest among the interstitial collaterals that branched out in L5 from the earlier-extended callosal projection. Collaterals to M1 elongated primarily within the cortical gray matter with little branching before reaching the target. Our results suggest that dual-projection neurons in S1 make a significant fraction of the association projections to M1, supporting the directed guidance mechanism in long-range corticocortical circuit formation over random projections followed by specific pruning.

Feasibility and safety of early initiation of a PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor in patients with acute myocardial infarction undergoing primary PCI

Background

Recent ESC/EAS Guidelines for the management of dyslipidemia stated that the treatment goal of LDL cholesterol (LDL-C) in very high-risk patients is less than 55mg/dl. PCSK9 inhibitors in addition to strong statins could be a useful strategy for rapid and aggressive lowering of LDL-C. However, the feasibility and safety of early initiation of a PCSK9 inhibitor for AMI patients undergoing primary PCI remain unclear.

Objectives

We examined the effects of early initiation of a PCSK9 inhibitor, evolocumab, on lipid profile and inflammatory markers and its safety in AMI patients undergoing primary PCI.

Methods

This study is a single center, randomized, controlled trial involving 102 patients hospitalized for AMI. The patients were randomly assigned 1:1 to the evolocumab group and the control group. Evolocumab (140 mg) was subcutaneously injected within 24 hours after PCI and then every two weeks. All patients received pitavastatin (2mg/day) in addition to the allocated treatment. The primary endpoints were changes in lipid profile and inflammatory markers from baseline to 4 weeks.

Results

102 patients were enrolled between October 2017 and December 2019. 89 patients were ST-segment elevation myocardial infarction (STEMI), 13 patients were non-STEMI. Primary PCI was successfully performed in all patients. 76 patients were statin-naïve. 2 patients were excluded from analyses because they died severe heart failure in acute phase. Finally, 100 patients (evolocumab; n=51 and control; n=49) were analyzed. Baseline LDL-C was 121.6±30.3 mg/dl in the evolocumab group and 124.7±33.6 mg in the control group. Change in LDL-C from the baseline to 4 weeks was −92.4±32.4 mg/dl (−75%) in the evolocumab group and −44.8±32.1 mg/dl (−33.1%) in the control group (mean difference; 47.6mg/dl, 95% CI; 34.8 to 60.4 mg/dl, p<0.001). LDL-C <70mg/dl at 4 weeks was achieved in 96.0% of the evolocumab group as compared with 26.5% of the control group. Further, in the evolocumab group. LDL <55mg/dl was achieved in 92.1% at 2 weeks and 92.1% at 4 weeks. Regarding inflammatory markers, there were no significant difference in change in high-sensitivity C-reactive protein (p=0.49) and tumor necrosis factor-alpha (p=0.63) between two groups even after adjustment of baseline value. No adverse event associated with evolocumab was observed during this study.

Conclusion

In patients with AMI undergoing primary PCI, early initiation of evolocumab rapidly reduced LDL-C without no adverse event, and achieved LDL-C<55mg/dl in most patients within 2 weeks. Early administration of a PCSK9 inhibitor combined with a strong statin could be a feasible and safe treatment for AMI patients undergoing PCI.

Funding Acknowledgement

Type of funding source: None

Scalp cooling for hair loss prevention in female Japanese breast cancer patients receiving (neo)adjuvant chemotherapy

PURPOSE

Scalp cooling during chemotherapy infusion has been recently reported to have moderate efficacy in the mitigation of chemotherapy-induced alopecia; however, there are few reports on Asian patients. We aimed to clarify the effects of scalp cooling in Japanese women.

PATIENTS AND METHODS

Female Japanese breast cancer patients who planned to receive (neo)adjuvant chemotherapy participated in this prospective study on the efficacy of scalp cooling using the Paxman Scalp Cooling System for alopecia prevention. The primary outcomes were the rates of patients with Grade 3 alopecia (defined as hair loss of > 50%) and the rates of patients who used a wig or hat to conceal hair loss 1 month after the last infusion of chemotherapy. The subjects were given a brief questionnaire regarding headaches, bad mood, fatigue, and chills shortly after each cooling.

RESULTS

One hundred and forty-three patients participated in the study and used the cooling cap at least once. The mean and median ages of the subjects were 50.6 and 50, respectively (age range 28-76). One hundred and twenty-nine patients completed the planned chemotherapy of 4 to 8 cycles. Among them (7 patients were not evaluable), 74 patients (60.7%) had Grade 3 alopecia 1 month after chemotherapy. Of 80 patients who used the scalp cooling system throughout the planned chemotherapy (1 patient was not evaluable), 36 patients (45.6%) experienced Grade 3 alopecia.

CONCLUSION

The efficacy of scalp cooling during chemotherapy infusion for hair loss mitigation in Asian women is similar to that in Caucasian women.

Abstract P5-14-21: Prospective study of hair recovery after (neo)adjuvant chemotherapy with scalp cooling in Japanese breast cancer patients

Introduction

Scalp cooling during chemotherapy infusion to mitigate hair loss for breast cancer patients is becoming popular in European and North American countries. But there is little prospective data regarding hair recovery after chemotherapy with scalp cooling. We reported on the results of hair loss prevention with scalp cooling during (neo)adjuvant chemotherapy with anthracyclines and/or taxanes for 122 Japanese breast cancer patients at the 2018 San Antonio Breast Cancer Symposium. Now we report on the prospective data of hair recovery of our 122 patients.

Patients and Methods

One hundred and twenty two Japanese breast cancer female patients who completed planned (neo)adjuvant chemotherapy used Paxman Scalp Cooling System for alopecia prevention and were evaluable for hair loss prevention in our prospective study. The scalp cooling was done 30 minutes prior to and during and 90 minutes after each chemotherapy infusion. We evaluated their hair recovery 1, 4, 7, 10, and 13 months after completion of the chemotherapy. We took photographs of the heads of the patients from 5 directions, namely front, back, both sides, and top and asked the patients about the use of a wig or hat to conceal the hair loss using a questionnaire at the times mentioned above. Primary outcomes were grades of alopecia judged by two investigators (defined as Grade 0: 0% of hair loss, G1: 1~25 %, G2: 26~50%, G3: > 50%)(objective grade) and patients' answers to the questionnaire (defined as Grade 0: not at all, G1: sometimes, G2: almost always)(subjective grade). Among 122 patients 79 completed scalp cooling during the whole planned chemotherapy cycles, but 43 discontinued it mostly after the first cycle due to several reasons. We compared the objective and subjective grades of hair loss between the patients who had completed the scalp cooling (79 patients: Group A) and those who had discontinued it (43 patients: Group B).

Results

Objective grades 1 month after completion of the chemotherapy were Grade 0 in 6 patients (4.9 %), G1 in 13, G2 in 29, and G3 in 74, and subjective grades at 1 month were Grade 0 in 3 patients (2.5 %), G1 in 13, G2 in 105, and unknown in 1. The changes over time in objective grades were as follows; 4 months: G0 55 (47.0 %), G1 52, G2 9, G3 1, unknown 5, 7 months: G0 99 (85.3 %), G1 15, G2 1, G3 1, unknown 6, 10 months: G0 105 (89.7 %), G1 10, G2 1, G3 1, unknown 5, 13 months: G0 104 (92.0 %), G1 7, G2 1, G3 1, unknown 9. On the other hand, the changes in subjective grades were as follows; 4 months: G0 12 (10.3 %), G1 29, G2 76, unknown 5, 7 months: G0 53 (45.7 %), G1 22, G2 41, unknown 6, 10 months: G0 80 (68.4 %), G1 15, G2 22, unknown 5, 13 months: G0 93 (82.3%), G1 7, G2 13, unknown 9. When we compared Group A with Group B, the rates of objective G0 were statistically significantly higher in Group A than Group B, at 4, 10, and 13 months (4 months: 55.7% vs. 28.9%, P = 0.010, 10 months: 96.1% vs. 78.0%, P = 0.006, 13 months: 97.3% vs. 81.6%, P = 0.011) and the rate of subjective G0 was also statistically significantly higher in Group A than Group B at 7 months (53.2 % vs. 30.8 %, P = 0.022). When we restricted the data to those with objective Grade 3 at 1 month, Group A showed tendency of faster hair recovery in the objective grades than Group B.

Conclusion

It is concluded that scalp cooling during chemotherapy infusion for Japanese breast cancer patients made their hair recovery faster.

Citation Format: Shozo Ohsumi, Sachiko Kiyoto, Yuichiro Miyoshi, Mina Takahashi, Seiki Takashima, Kenjiro Aogi, Sachie Shimizu, Miyuki Doi. Prospective study of hair recovery after (neo)adjuvant chemotherapy with scalp cooling in Japanese breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-14-21.

Kcnab1 Is Expressed in Subplate Neurons With Unilateral Long-Range Inter-Areal Projections

Subplate (SP) neurons are among the earliest-born neurons in the cerebral cortex and heterogeneous in terms of gene expression. SP neurons consist mainly of projection neurons, which begin to extend their axons to specific target areas very early during development. However, the relationships between axon projection and gene expression patterns of the SP neurons, and their remnant layer 6b (L6b) neurons, are largely unknown. In this study, we analyzed the corticocortical projections of L6b/SP neurons in the mouse cortex and searched for a marker gene expressed in L6b/SP neurons that have ipsilateral inter-areal projections. Retrograde tracing experiments demonstrated that L6b/SP neurons in the primary somatosensory cortex (S1) projected to the primary motor cortex (M1) within the same cortical hemisphere at postnatal day (PD) 2 but did not show any callosal projection. This unilateral projection pattern persisted into adulthood. Our microarray analysis identified the gene encoding a β subunit of voltage-gated potassium channel (Kcnab1) as being expressed in L6b/SP. Double labeling with retrograde tracing and in situ hybridization demonstrated that Kcnab1 was expressed in the unilaterally-projecting neurons in L6b/SP. Embryonic expression was specifically detected in the SP as early as embryonic day (E) 14.5, shortly after the emergence of SP. Double immunostaining experiments revealed different degrees of co-expression of the protein product Kvβ1 with L6b/SP markers Ctgf (88%), Cplx3 (79%), and Nurr1 (58%), suggesting molecular subdivision of unilaterally-projecting L6b/SP neurons. In addition to expression in L6b/SP, scattered expression of Kcnab1 was observed during postnatal stages without layer specificity. Among splicing variants with three alternative first exons, the variant 1.1 explained all the cortical expression mentioned in this study. Together, our data suggest that L6b/SP neurons have corticocortical projections and Kcnab1 expression defines a subpopulation of L6b/SP neurons with a unilateral inter-areal projection.

Abstract P4-16-13: Prospective study of scalp cooling for hair loss prevention in Japanese breast cancer women receiving (neo)adjuvant chemotherapy

Introduction

Recently scalp cooling during chemotherapy infusion has been reported to be quite effective to mitigate chemotherapy-induced alopecia. But data in Asian patients are quite limited.

Patients and methods

Japanese breast cancer female patients who planned to receive (neo)adjuvant chemotherapy were offered to participate in this prospective study of scalp cooling with Paxman Scalp Cooling System for alopecia prevention. The scalp cooling was done 30 minutes prior to and during and 90 minutes after each chemotherapy infusion. Photographs of the head of the participants were taken from 5 directions, namely front, back, both sides, and top, on the day of chemotherapy infusion and 1 month after the last infusion. Two investigators consisting of a physician and a nurse judged the grade of alopecia by looking at the photographs according to the WHO classification. The primary outcomes were the rates of patients with Grade 3 alopecia (defined as hair loss of > 50%) and the rates of patients who used a wig or hat to conceal the hair loss one month after the last infusion of chemotherapy. This paper reports on the former outcome mainly. They were asked to answer a brief questionnaire regarding headache, fatigue, chill etc. shortly after each cooling. They could use the cooling cap for free on the first cycle of chemotherapy. But they were required to purchase it (about 1,130 US$) for the scalp cooling of the following cycles.

Results

One hundred forty three patients participated in the study and actually used the cooling cap at least once. The mean and median age of them are 50.6 and 50, respectively (28 - 76). One hundred twenty nine patients completed the planned chemotherapy of 4 to 8 cycles (89 Pts 4 cycles, 1 Pt 6 cycles, 39 Pts 8 cycles). Among them (7 patients were not evaluable), 74 patients (60.7 %) had Grade 3 alopecia 1 month after chemotherapy. In 80 patients who used the scalp cooling system throughout the planned chemotherapy (1 patient was not evaluable), 36 patients (45.6 %) experienced Grade 3 alopecia. On the other hand, among 49 patients who discontinued the cooling mostly after the 1st cycle (6 were not evaluable), 38 (88.3 %) had Grade 3 alopecia. When we restrict them to 33 (5 were not evaluable) who decided to discontinue the cooling by day10 of the first cycle of chemotherapy to exclude the patients who discontinued it because of less effect on alopecia prevention than they expected, 25 (89.3 %) experienced Grade 3 alopecia. Comparing the results of those who completed the cooling and patients who decided to discontinue it by day10 of the first cycle, the rates of Grade 3 alopecia (45.6 % vs. 89.3 %) were statistically significantly different in favor of the former (P = 0.0001). Most patients complained of some headache, chill, and pain of the jaw.

Conclusion

Scalp cooling with Paxman Scalp Cooling System during chemotherapy infusion in Asian women seems as effective for hair loss mitigation as in Caucasian women.

Citation Format: Ohsumi S, Kiyoto S, Takahashi M, Hara F, Takashima S, Aogi K, Matsuda M, Yamamura N, Matsuda A, Yamauchi T, Doi M. Prospective study of scalp cooling for hair loss prevention in Japanese breast cancer women receiving (neo)adjuvant chemotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-16-13.

Clinical features and outcomes of Merkel cell carcinoma in 20 cats

The biological behaviour and prognostic factors of Merkel cell carcinoma (MCC) in 20 cats were studied. The tumours were surgically removed and histopathologically examined. The animals were 8 to 20 years old (median age: 14 years), and the tumours were predominantly located in the neck and head. Follow-up data were available in 17 cases, and 12 cats died within a year of surgery. The overall median survival time after resection was 243 days (range 16-360 days). Recurrence occurred in 11 cases, although 6 of them (55%) were found to be margin-negative. Possible metastasis occurred after the surgery in 10 cases, although 6 of them (60%) were found to be margin-negative. The histopathological features of MCC included tumour necrosis in 16 cases (80%), vascular invasion in 6 cases (38%) and high mitotic counts (median: 28.5 per high-power field). Irregular acanthosis was noted adjacent to the tumours in 9 cases (60%). Immunohistochemically, the tumour cells were positive for cytokeratin (CK) 20 and p63 in all cases, synaptophysin in 19 (95%) cases, and CK18 in 16 cases (80%). The study shows that feline MCC is associated with a poor prognosis and exhibited a strong tendency towards local recurrence, regional lymph node metastasis and distant spread.

Changes in resting-state brain networks after cognitive-behavioral therapy for chronic pain

BACKGROUND

Cognitive-behavioral therapy (CBT) is thought to be useful for chronic pain, with the pathology of the latter being closely associated with cognitive-emotional components. However, there are few resting-state functional magnetic resonance imaging (R-fMRI) studies. We used the independent component analysis method to examine neural changes after CBT and to assess whether brain regions predict treatment response.

METHODS

We performed R-fMRI on a group of 29 chronic pain (somatoform pain disorder) patients and 30 age-matched healthy controls (T1). Patients were enrolled in a weekly 12-session group CBT (T2). We assessed selected regions of interest that exhibited differences in intrinsic connectivity network (ICN) connectivity strength between the patients and controls at T1, and compared T1 and T2. We also examined the correlations between treatment effects and rs-fMRI data.

RESULTS

Abnormal ICN connectivity of the orbitofrontal cortex (OFC) and inferior parietal lobule within the dorsal attention network (DAN) and of the paracentral lobule within the sensorimotor network in patients with chronic pain normalized after CBT. Higher ICN connectivity strength in the OFC indicated greater improvements in pain intensity. Furthermore, ICN connectivity strength in the dorsal posterior cingulate cortex (PCC) within the DAN at T1 was negatively correlated with CBT-related clinical improvements.

CONCLUSIONS

We conclude that the OFC is crucial for CBT-related improvement of pain intensity, and that the dorsal PCC activation at pretreatment also plays an important role in improvement of clinical symptoms via CBT.

Clinical porcine islet xenotransplantation under comprehensive regulation

BACKGROUND

Xenotransplantation with porcine islets is a promising approach to overcome the shortage of human donors. This is the first report of phase 1/2a xenotransplantation study of encapsulated neonatal porcine islets under the current framework of regulations for xenotransplantation in New Zealand.

METHODS

Newborn piglets were anesthetized and bled, and the pancreata were removed with the use of sterile technique and processed. Encapsulated neonatal porcine islets were implanted with the use of laparoscopy into the peritoneal cavity of 14 patients with unstable type 1 diabetes without any immunosuppressive drugs. The patients received encapsulated islets of 5,000 (n = 4; group 1), 10,000 (n = 4; group 2), 15,000 (n = 4; group 3), or 20,000 (n = 2; group 4) islet equivalents per kg body weight. Outcome was determined from adverse event reports, HbA1c, total daily insulin dose, and frequency of unaware hypoglycemic events. To assess graft function, transplant estimated function (TEF) scores were calculated. Sufficient or marginal numbers of encapsulated neonatal porcine islets were transplanted into streptozotocin-induced diabetic B6 mice as an in vivo functional assay.

RESULTS

There were 4 serious adverse events, of which 3 were considered to be possibly related to the procedure. Tests for porcine endogenous retrovirus DNA and RNA were all negative. The numbers of unaware hypoglycemia events were reduced after transplantation in all groups. Four of 14 patients attained HbA1c <7% compared with 1 at baseline. The average TEF scores were 0.17, 0.02, -0.01, and 0.08 in groups 1, 2, 3, and 4 respectively. The in vivo study demonstrated that a sufficient number of the transplanted group reversed diabetes with positive porcine C-peptide.

CONCLUSIONS

Transplantation of encapsulated neonatal porcine islets was safe and was followed by a reduction in unaware hypoglycemia events in unstable type 1 diabetic patients. The mouse in vivo assessment data demonstrated certain graft function.